OUR EXPERIENCE IN TREATMENT OF ENTEROATMOSPHERIC FISTULAS FORMED AS A RESULT OF MINE-EXPLOSIVE INJURY

Abstract

A mine-explosive injury is a special type of injury, and in most cases, the surgeon encounters a victim with polytrauma, including an injury to the organs of the abdominal cavity. However, 87% of all penetrating wounds of the abdominal cavity are accompanied by intestinal damage, which in the future can lead to the formation of enteroatmospheric fistulas. The study aimed to improve the results of surgical treatment of patients with enteroatmospheric fistulas formed as a result of a mine-explosive injury with a penetrating wound of the abdominal cavity. Material and Methods. The results of the treatment of 17 victims with enteroatmospheric fistulas, which were formed as a result of a mine-explosive injury with a penetrating wound of the abdominal cavity, were analyzed. All patients were treated in the surgical department of the Communal non-commercial institution of the Kharkiv Regional Council "Regional Clinical Hospital" during 2022-2023. There were 9 (52.9%) female patients, 8 (47.1%) male patients. The age of the patients varied from 42 to 75 years. Results. The study shows that only 4 (23.5%) patients had isolated intestinal injury, the other 13 (76.5%) had combined and multiple injuries. All 13 patients (except for the intestinal injury) had shrapnel wounds and penetrating injuries to the limbs, of which 4 had a traumatic hemopneumothorax, 4 had kidney and retroperitoneal injury, 3 had liver injury, and 2 had pancreas and retroperitoneal injury. , in 2 - injury of the spleen, in 1 - violation of the integrity of the pelvic bones. A comprehensive approach to the treatment of patients was implemented. The first stage is the opening and drainage of an abscess in the presence of an abscess on the front abdominal wall. The second stage is the delimitation of the intestinal fistula with one's tissues or with the help of various "fistula adapters". Next, VAC bandages were installed for active drainage. After debridement, tissue defects of the anterior abdominal wall were plasticized with own tissues or ointment bandages were used, sites were formed for the calorimeter (if there is a discharge of intestinal contents from the fistula) or places for an ointment bandage (if there is no secretion of intestinal contents). Discussion. Enteroatmospheric fistula is a subtype of enterocutaneous fistula, and represents a connection between the gastrointestinal tract and the external atmosphere without a vascularized covering of soft tissues. Enteroatmospheric fistula can develop along any part of the gastrointestinal tract. Conclusions. We believe that the scheme of treatment of enteroatmospheric fistulas will help to achieve significant success in the treatment of this category of patients, and the proposed algorithm will make it possible to avoid the next possible laparotomy. Also, if we take into account the economic aspect, it is economically less expensive to treat enteroatmospheric fistulas according to this algorithm than to carry out a massive surgical intervention.

Keywords

• hypertension
• children
• metabolic syndrome
• waist circumference
• adolescents
• heredity
• sleepiness